ArticleJournal of the American College of Emergency Physicians open2025
Management of Primary Spontaneous Pneumothorax in the Emergency Department: A Cost-Effectiveness Analysis.
Article in Journal of the American College of Emergency Physicians open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Should we abandon the simple aspiration in favour of chest tube drainage in the management of spontaneous pneumothorax? A systematic review and meta-analysis.BMC pulmonary medicine · 2026Pooled it
- Efficacy and cost-effectiveness of VATS versus chest tube drainage in first-episode primary spontaneous pneumothorax with blebs: a propensity score-matched retrospective study.BMC pulmonary medicine · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: Primary spontaneous pneumothorax (PSP) is a common emergency condition among healthy individuals that presents significant management challenges, particularly in cases of moderate-to-large collapse, which have traditionally required intervention. Recent trials, including a landmark-randomized trial, have demonstrated effectiveness in 4 separate strategies: (1) observation only, (2) needle aspiration, (3) small-bore chest tubes with a 1-way valve, and (4) small-bore chest tubes with continuous suction. We compare the cost-effectiveness of these 4 strategies. Methods: We conducted a cost-effectiveness analysis from a US healthcare system perspective to compare 4 management strategies for moderate-to-large PSP in stable adult emergency department patients. Using published randomized controlled trials and secondary data, we developed a decision-analytic model with a lifetime horizon. Costs (2022 USD), quality-adjusted life-years, and net monetary benefit (NMB) were calculated at a $50,000/quality-adjusted life-years willingness-to-pay threshold and 3% annual discount. We performed 1-way and probabilistic sensitivity analyses to test the robustness of findings. Results: Base case analysis identified observation only as the most cost-effective strategy, achieving the highest NMB ($43,696). The NMB values for small-bore chest tubes with a 1-way valve, needle aspiration, and small-bore chest tube with continuous suction were $33,520, $29,465, and $12,831, respectively. Sensitivity analyses indicated that factors such as initial success rates for observation and needle aspiration influenced model outcomes, whereas probabilistic simulations confirmed observation only as the dominant strategy. Conclusions: Observation alone is the most cost-effective initial strategy for stable moderate-to-large PSP, although its feasibility may be limited. Among interventional options, a small-bore chest tube with a 1-way valve offers the best value and enables outpatient management. Further studies in diverse settings are needed to confirm the practicality of observation only care and consider individual patient factors.
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